psychotic and mood disordersravanpezeshkan.com/wp-content/uploads/2014/10/... · md ai phtin ifi...
TRANSCRIPT
Psychotic andPsychotic andMood Disorders
ی با ر ر ا دی پزش یاران سال اول روا یکلاس د پز ل ل ن ی س
ان؛ وه ی ا وم پزش ه ع ی دا پزش 93/6/16روا
22
M d A i P h ti N ifi
SymptomsMood Anxious Psychotic Non-specific
Depressed mood Anxiety/Worry Delusion Aggression
Loss of interest Phobia Hallucination Agitation/RestlessnessLoss of interest Phobia Hallucination Agitation/Restlessness
Elevated mood Rumination Disorganized speech Irritability
Hopelessness Avoidance Disorganized behavior ImpulsivityHopelessness Avoidance Disorganized behavior Impulsivity
Worthlessness Safety behaviors Mood swing
Helplessness Hypervigilance Talkativeness
Guilt feeling Panic attack Grandiosity
Attempted suicide Safety behaviors Difficulty concentrating
O ti it R tl S lf i jOveractivity Restlessness Self-injury
Overfamiliarity Exaggerated startle response Insomnia
Being easily fatiguedg y g
Symptom → Syndromey p y
Depressed mood + Loss of interest +
Insomnia + Low self-esteem + Hopelessness p
Major Depressive Episode
44
Symptom → Syndromey p y
A i
GAD
Adjustment DisorderTalkativeness Anxiety
Substance-induced
Adjustment Disorder
Compulsion OCDOrganic
Manic Episode Bipolar Disorder
Schizoaffective Disorder
Hyperthyroidism
Schizoaffective Disorder
Substance-induced
55OrganicSubstance-induced/Abuse
MoodMood
Depressed mood/ Loss of interest
Elevated/ Expansive moodElevated/ Expansive mood
Irritable mood (Less specificity)
Affective instability (Less specificity)
66
Adjustment
MDD
Adjustment
Dysthymic
MDD
Rec Brief
y y
Minor dep
Bip dep
0% 20% 40% 60% 80% 100%
88
يهاي كليدي اختلال دوقطبي نشانه
Depressed mood
L f i t tLoss of interest
Euphoria
Irritability
Overactivity
99
ييهاي اختلال دوقطبي ويژگي
Highly recurrent
Familial [etiology]
Depression: Predominant affect
Hypo/mania: Hallmark
Depression: Predominant affectProfound disability
Suicide: a major outcome
Subsyndromal symptoms: Predominant features
j
1010Comorbidity is the rule rather than exception.
I th li iIn the clinic:
depression/anxiety symptoms > i / imania/hypomania symptoms
1111
Bipolar I DisorderBipolar I Disorder
MajorMania Major Depression
Bipolar I DisorderBipolar I Disorder
Major Mania
jDepression
MixedMixed
Bipolar I DisorderBipolar I Disorder
M i H i
Mania Hypomania
Psychosis+
+ ―
Dysfunction+ ―+ ―
Significant aggression+ ―+
Duration ≥ 7 days or any if aggression
≥ 4 daysgg
Bipolar II DisorderBipolar II Disorder
Hypo MajorHypo-mania
Major Depression
Bipolar II DisorderBipolar II Disorder
1818
PsychosisPsychosis
Delusion
HallucinationHallucination
Disorganized speech
Disorganized behavior
1919
2020
Bryan Charnley, 1991
“Mania” whose author is Florencio Yllana, a contemporary artist of Philippine origin (bornPhilippine origin (born 1977), presently living in Brazil. The painting was done in 2001 following the acute manic episode in the course of BD in the artist (Rybakowski JK 2010)artist. (Rybakowski JK, 2010)
2121
Psychotic DisordersPsychotic Disorders
Schizophrenia
Schizoaffective DisorderSchizoaffective Disorder
Delusional Disorder
Brief Psychotic Disorder
Another Medical ConditionAnother Medical Condition
Substance-induced
2222
Psychotic+Affective
Psychotic+ Affective Remission Psychotic+
Affective
Psychotic+ Affective Psychotic Psychotic+Affective
Psychotic+ Affective Affective Psychotic+
Affective
Psychotic+ PsychoticPsychotic+ Affective Psychotic Affective Psychotic
+Affective
Treatment OptionsTreatment Options
Placebo; Sham ECT
Medications
Psychotherapy
ECT
rTMS
VNS
Antidepressants: 8) NDRIs (bupropion)
1) TCAs (imipramine)
2) Atypical TCAs (mianserin)
10) NASSAs (mirtazapine)
11) MASSAs (agomelatine)2) Atypical TCAs (mianserin)
3) MAOIs (tranylcypromine)
11) MASSAs (agomelatine)
12) SSREs (tianeptine)
4) RIMAs (moclobemide) 13) Serotonin Modulator and Stimulator (vortioxetine)
5) SSRIs (fluoxetine)
6) SNRIs (venlafaxine)
14) SRI+5HT1aPA (vilazodone)
6) SNRIs (venlafaxine)
7) NRIs (reboxetine)
15) Herbal: St. John's wort
16) SNDRIs (amitifadine)
8) SARIs (trazodone)
) ( )
Treatment algorithmg
Remission
New drugPartial remission
Increase ORAugmentation/ Combination
Poop out
No Response Switch
Poop out = losing the efficacy
Augmentation agents:1) Folic acid1) Folic acid
2) Omega-3 fatty acids
3) Buspirone
4) SGAs
5) Stimulants
6) Liothyronine
7) Lithium
8) Wake-promoting agents:8) Wake promoting agents:
modafinil
9) D i i t9) Dopamine agonists:
pramipexole
Major side effectsMajor side effects
Lithium Renal failure Toxicity Diabetes i i idinsipidus
Valproate Teratogenicity Hepatotoxicity
Lamotrigine Serious rash
i l i b lli li id i i h iAtypical antipsychotics
Diabetes mellitus Hyperlipidemia Weight gain
2828
Strengths Weaknesses
i hi i i id i iLithium Antisuicide Toxicity
Valproate High tolerance For women in Valproate High tolerance For women in fertility ages
Lamotrigine High tolerance TitrationNo weight gain
Low teratogenicityNo antimanicSerious rash
Atypical Antipsychosis Metabolic ypantipsychotics
p ysyndromes
2929
3030